Abstract: PD09-11
Sources of Funding: None

Introduction

The undescended testicle (UDT) presents a problem in post-pubertal (PP) men as it carries an increased risk of developing a testicular germ cell tumor (GCT). Management of the PP patient with an UDT must weigh the relative risk of peri-operative mortality (POM) to remove the UDT against the lifetime risk of death from developing a GCT. _x000D_ The most recent analysis of this management dilemma is 15 years old and utilizes now outdated data. In their paper, investigators found that men who are healthy (ASA 1 or 2) should be advised to undergo orchiectomy, while those older than 50 should be advised to remain under close observation. _x000D_ However, newer studies on the prevalence of UDT, GCT mortality rates and POM risk may change this recommendation. We undertook an update to this previous report as these more contemporary data may establish new criteria in the management of the PP UDT._x000D_

Methods

The most recent data on GCT mortality in the U.S. were obtained from the National Center for Health Statistics. The lifetime risk of death from GCT in the male population was calculated for each 5-year interval. Standard life tables were used to calculate the cumulative risk over a man’s lifetime based on the age at presentation. _x000D_ The prevalence of UDT in PP males and the percentage of men with GCT who have a history of UDT were identified through literature search. The relative risk of GCT in men with UDT was expressed as the ratio of observed to expected prevalence of UDT among patients with GCT. The prevalence of UDT in GCT men was calculated as a weighted value based on the number of patients in each individual study. _x000D_ As there is no orchiectomy specific POM data, we utilized data from patients undergoing similar (“low risk�) surgical procedures stratified by ASA class. Orchiectomy was considered a low risk procedure based on the Cleveland Clinic cardiac risk stratification for non-cardiac surgery._x000D_ Mortality rates were plotted to determine the age when ASA class specific POM exceeds the risk of mortality from GCT. _x000D_

Results

Lifetime risk of dying from GCT decreases with increasing age. POM exceeded risks of death from GCT for men after age 46 for ASA class 1 and age 25 for ASA class 2. Men with an ASA class higher than 2 have a higher risk of POM compared to GCT for all ages.

Conclusions

Previous evaluations in the management of men with PP UDT required updating. We found a lower age at which observation is advised compared to the previous report. Thus, we advocate for prophylactic orchiectomy only in men who are under 46 years if ASA class 1 and under 25 years if ASA class 2. Men with an ASA class higher than 2 should always undergo observation.

Funding

None